President Trump’s executive order on health care yesterday is breathtakingly bad. His administration’s announcement last night that it would stop funding critical insurance subsidies, which reduce low-income Americans’ out-of-pocket spending, is even worse.
Both will do great harm to the U.S. individual insurance markets. Both will drive insurers out of fragile markets, raise premiums and reduce access to care. What’s more, they will likely cost the government money.
In August, the Congressional Budget Office found that killing the cost-sharing subsidies alone would increase the federal deficit, on net, by $194 billion from 2017 through 2026. That’s because of a strange quirk in how the subsidies are designed.
Of course, Trump claims that he’s merely making the health-care system better.
As he said in his executive order signing ceremony yesterday: “This is promoting health care choice and competition all across the United States. This is going to be something that millions and millions of people will be signing up for, and they’re going to be very happy. This will be great health care.”
His actions are so at odds with his words that it’s hard to know if Trump actually thinks he is improving the health-care system, and is just getting bad advice; or if this is all just a nihilistic attempt to blow up the system and destroy health care for everyone.
When it comes to evaluating bad government behavior, I usually err on the side of blaming incompetence rather than malevolence.
But Trump has publicly and repeatedly declared his intentions to sabotage the current system and “let Obamacare fail.” Whether or not he really is aware of what’s going on, his administration has taken other deliberate steps to destabilize insurance markets.
The Department of Health and Human Services has slashed advertising for open enrollment, for example, and even used Obamacare money to run ads against it. It has announced that healthcare.gov will be offline for nearly every Sunday during open enrollment. Trump has occasionally suggested that he’ll stop enforcing the individual mandate, which means that only the sickest people will be motivated to purchase insurance, further destabilizing markets.
And so on.
Health care is complicated. Insurance is complicated. I suppose it’s possible that Trump just has no clue what everyone around him is doing, and/or doesn’t fully understand the implications of his recent actions — and has actually convinced himself that “there will be great health care.”
On some level, of course, the intentions may not matter. Bad policy is bad policy, no matter the motivations.